Helping adults with severe mental illness get a job and to keep it, a network meta-analysis
What is the aim of this review?
The aim of this review was to find out if it is possible to help adults with severe mental illness get a job and to keep it.
People with severe mental illness, such as schizophrenia or bipolar disorder, are more often unemployed. However, these people still often have a desire to work. There are many ways to try and help them obtain a competitive job. People with severe mental illness used to be placed in sheltered employment or they were enrolled in prevocational training, before searching for competitive work. Now there are also interventions focusing directly on finding a job quickly, with ongoing support to keep the job. This is known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions.
Supported employment and augmented supported employment are more effective than the other interventions in obtaining and maintaining competitive employment for people with severe mental illness without increasing the risk for hospital admissions. The difference in effectiveness between supported employment and augmented supported employment is small. Future research should evaluate the cost-effectiveness of augmented supported employment compared to supported employment only.
What was studied in the review?
We included 48 randomised controlled trials involving 8743 participants. The interventions included prevocational training, transitional employment, such as sheltered jobs, supported employment, supported employment augmented with other specific interventions or psychiatric care only. We used the data from these studies about the number of participants who obtained a competitive job and the number of weeks they worked. Through a direct comparison meta-analysis and a network meta-analysis we assessed the difference in effectiveness between all interventions, and ranked these accordingly.
What are the results of the review?
Supported employment and augmented supported employment are more effective than prevocational training, transitional employment or psychiatric care only in obtaining employment in both types of meta-analysis. In the direct comparison meta-analysis prevocational training was also more effective than psychiatric care only. Augmented supported employment shows slightly better results than supported employment alone, again in both types of meta-analysis. However, this result was less clear in the network meta-analysis. In the subgroup analysis supported employment with symptom-related skills training showed the best results. The results are based on moderate- to very low-quality evidence, meaning that the results of future studies could change our conclusions. Augmented supported employment is more effective than prevocational training and supported employment in maintaining competitive employment in the direct comparison meta-analysis. The results favour supported employment compared to transitional employment in maintaining competitive employment.
Overall, we did not find any differences between interventions in the risk of participants dropping out or hospital admissions.
How up to date is this review?
We searched for studies that had been published up to 11 November 2016.